Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 10/3/2024
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: County Clerk
5) Department Contact: Mae Ross
6) Description: Election Software
7) PEID No: 719958
8) Req No:
9) Orgkey: 1101114030
10) Object Code: 5481000
11) Vendor: 14 Oranges
12) Vendor Contract No: CM17257
Expenditure Budget/Revenue Projections
13) Fund Name: Election Expense
14) Fund #: 1101
15) Current Year Budgeted: 5,000
16) Current Year Projected: 4,500
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 10/27/2024
23) Auto Renewal Contract: Yes
24) Bid No: NA
25) Contract End Date: 10/26/2024
26) Contract # Issued by Purchasing Department:
NOTES: HB1295 on file